How practices can ensure all patients have access to dental care, while reducing reliance on Medicaid
Medicaid is run jointly by federal and state governments to provide health care and long-term care coverage for more than 81 million Americans, including children, parents, low-income adults, older adults, and people with disabilities. The federal government sets general standards for Medicaid, but specific eligibility requirements and coverage details vary by state.
For some practices, participating in Medicaid dental coverage may seem like the only way to serve low-income patients, but the program’s low reimbursements and bureaucratic hurdles strain resources. Plus, fewer and fewer patients even have access to Medicaid programs. Fortunately, there is an alternative strategy that allows dental offices to ensure all patients can receive quality care while reducing dependence on Medicaid.
The unpredictability of Medicaid dental coverage can pose challenges for practices and patients
Medicaid dental coverage is inconsistent across the US, creating a patchwork of access and affordability that can vary significantly depending on where you live. In some states, Medicaid offers comprehensive dental care, while in others, benefits are limited to emergencies or entirely nonexistent.
Dentists are left trying to balance their commitment to care with the realities of running a business. Medicaid’s regional variability means that providers in less-supported states, particularly rural areas, are at a disadvantage.
If only to add fuel to the fire, as of September 2024, more than 25 million Medicaid enrollees have been disenrolled due to the unwinding of Medicaid expansion under the continuous enrollment provision. This has left more patients without coverage, prompting dentists to question how the instability of the program can serve a purpose in their practice.
Medicaid isn’t the only solution to help patients access affordable dental care
Research consistently shows that Americans without some form of dental coverage forgo dental visits and treatment due to the high cost of care. One study found that when patients gained dental coverage through Medicaid, they were more likely to visit the dentist. However, if not all patients have access and providers have additional hurdles to overcome, the key is finding an alternative that truly works for both sides.
Dental membership plans work to create an ecosystem of shared value. Patients gain access to high-quality, affordable care that fosters a trusted, one-on-one relationship with their provider. At the same time, practices benefit from the opportunity to generate recurring revenue, adding a strengthened layer of predictability and control over their business.
How dental membership plans fit when evaluating Medicaid and fee-for-service models
In 2024, the national average Medicaid reimbursement for dental services is 29.9%. With shrinking reimbursements, some practices may choose to no longer accept Medicaid programs, and some may choose to switch to a fee-for-service model.
While these options may seem simpler, it puts patients in a position to deprioritize care, leaving your practice with unpredictable revenue, and patients at risk of neglecting necessary treatment. Membership is the key to bridging the gap.
Dental membership plans reshape how patients engage with care, establishing a commitment to your practice and improving both the frequency of visits and the rate of treatment acceptance.
Tailoring your dental membership plan to meet the unique needs of your practice
There’s more than one way to structure a dental membership plan, and practices can customize them to fit their patients’ needs.
For populations traditionally served by Medicaid, some practices choose to offer a low-cost membership plan option to more easily encourage patients to become members. Lower-cost plans can offer basic, low-cost procedures, such as a set number of exams and x-rays. They also offer savings on additional treatments, making it easier for patients to accept care.
Alternatively, you could choose to offer a slightly higher cost plan that includes hygiene, preventive, and diagnostic care, which are crucial for encouraging routine visits. Since 75% of treatment is diagnosed during hygiene appointments, these plans are instrumental in identifying issues early and driving case acceptance.
Whether offering low-entry or standard plans, practices remain in control of treatment inclusions, pricing structures, and the overall design of the plan. This flexibility allows them to tailor offerings based on their specific patient base and business goals, without being tied to the limitations of Medicaid.
Questions to consider when implementing a dental membership plan
While considering implementing an in-house dental membership plan vs through a partnership with a plan provider, you should first ask yourself several key questions.
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Will our team be able to build and price plans, standardize implementation, and measure and report on our progress?
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Are we prepared to handle the complexities of managing member payments, renewals, and the usage of benefits?
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Are there other competing priorities that could negatively impact our membership plan from being launched and managed effectively?
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Do we have the bandwidth to field patient inquiries and questions?
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Dental membership plans are subject to regulation, and there are penalties for non-compliance. Are we capable of building a DMPO compliant plan?
Assessing these factors will help you identify the right tools and support needed to grow and scale your dental membership plan.
If choosing a reliable partner is your path forward, Kleer and Membersy provides all your practice needs to reach your goals, without any of the challenges that comes with administering your own plan.
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Empower your team with software designed to manage subscriptions, automate renewals and handle billing, with both monthly and annual payment options available.
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Integrate with your practice management system to automatically enroll patients, track which savings have been used, and post payments. You can even automatically market and invite patients to join.
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Access training to help your team feel confident in providing the plan to patients.
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Take member questions off your team’s plate with dedicated member support.
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Kleer and Membersy is licensed where you operate and keeps your plan DMPO compliant.
With a Kleer and Membersy powered membership plan, you can serve patients who might otherwise depend on Medicaid while improving your practice’s financial health. If you’re interested in taking the next step, reach out to a plan expert.
About the author
Lynnea is a Demand Generation Analyst at Kleer and Membersy, specializing in the B2B SaaS industry. With a prior background in content marketing, Lynnea works to create strategic content for dental teams designed to improve business outcomes.
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